Individual provider Active NPI

Gerald Kane O'Bryan, M.D.

  • Internal Medicine Physician
  • Houma, LA
National Provider Identifier
1629259478
Registry record updated Oct 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
201218 Issued in LA
Practice address
1990 Industrial Blvd
Houma, LA 70363-7055
Phone
(985) 868-9300
Fax
(985) 851-0053
NPI assigned
Nov 21, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 201218 LA
Internal Medicine Physician 207R00000X 201218 LA Primary

Addresses

Primary practice location

1990 Industrial Blvd
Houma, LA 70363-7055

Mailing address

3650 Loyola Dr Apt 108
Kenner, LA 70065-5431
Phone (504) 467-8771

Other identifiers 1

IdentifierTypeStateIssuer
1073806MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091013000252 LA Practitioner - Internal Medicine 6406992080 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Arkansas College of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Louisiana Medical AssociatesGroup PAC ID 8527968650, 112 clinicians

Practice addresses (Care Compare)

1990 Industrial Blvd
Houma, LA 70363-7055
Phone (985) 868-9300

Hospital & facility affiliations

  • Ochsner Home Health of Raceland Home health agency, Raceland, LA, CCN 197119
  • Leonard J Chabert Medical Center Hospital, Houma, LA, CCN 190183
  • Ochsner St Mary Hospital, Morgan City, LA, CCN 190014
  • Terrebonne General Medical Center - Parish Hospital, Houma, LA, CCN 190008
  • Ochsner Medical Center Acute Hospital, New Orleans, LA, CCN 190036

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
201218LAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Louisiana Medical Associates Emergency Medicine CurrentSince Sep 1, 2009 Accepting new patients
South Louisiana Medical Associates CurrentSince Sep 1, 2009 Accepting new patients
South Louisiana Medical Associates Internal Medicine Past Accepting new patients
Southern Regional Medical Corporation Past Accepting new patients

Locations

1990 Industrial Blvd
Houma, LA 70363
Phone (985) 868-9300

1978 Industrial Blvd
Houma, LA 70363
Phone (985) 873-1814

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349827200000",
    "number": "1629259478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 LOYOLA DR APT 108",
            "city": "KENNER",
            "state": "LA",
            "postal_code": "700655431",
            "telephone_number": "504-467-8771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1990 INDUSTRIAL BLVD",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703637055",
            "telephone_number": "985-868-9300",
            "fax_number": "985-851-0053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BRYAN",
        "first_name": "GERALD",
        "middle_name": "KANE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-21",
        "last_updated": "2012-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "LA",
            "license": "201218",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "201218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073806",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houma, LA

Sources for this page

Verify at the official NPI Registry.